中国综合临床
中國綜閤臨床
중국종합림상
CLINICAL MEDICINE OF CHINA
2011年
1期
69-72
,共4页
姚志娟%张文丽%孙丽华%彭贝贝%王钧%张宏宇%孟庆祥%郭乃榄
姚誌娟%張文麗%孫麗華%彭貝貝%王鈞%張宏宇%孟慶祥%郭迺欖
요지연%장문려%손려화%팽패패%왕균%장굉우%맹경상%곽내람
异基因造血干细胞移植%侵袭性真菌感染%高危因素
異基因造血榦細胞移植%侵襲性真菌感染%高危因素
이기인조혈간세포이식%침습성진균감염%고위인소
Allogeneic hematopoietic stem cell transplantation%Invasive fungal infection%High-risk factor
目的 探讨异基因造血干细胞移植患者发生侵袭性真菌感染的高危因素、临床特点、治疗和预后.方法 分析我科2002年3月至2010年7月行造血干细胞移植术100例患者发生侵袭性真菌感染26例患者的临床资料.造血干细胞移植前发生肺部真菌感染7例;造血干细胞移植后发生肺部真菌感染14例,呼吸道真菌感染3例,肠道真菌感染2例.观察侵袭性真菌感染患者的移植物抗宿主病的发生、巨细胞病毒血症发生、淋巴细胞亚群检测、合并其他慢性基础疾病情况.将侵袭性真菌感染患者分为2组,拟诊经验性治疗组12例及临床诊断抢先治疗组14例.结果 26例侵袭性真菌感染的患者合并移植物抗宿主病20例,合并巨细胞病毒血症6例,细胞免疫功能低下的19例.合并糖尿病5例,肺结核3例,支气管扩张1例.经验性治疗组完全治愈8例(67%),疾病进展1例(8%).抢先治疗组完全治愈3例(21%);疾病进展5例(36%),2组比较差异有统计学意义(χ2=5.418,P<0.05).结论 造血干细胞移植存在侵袭性真菌感染高危因素的患者更应引起临床医师高度的重视.
目的 探討異基因造血榦細胞移植患者髮生侵襲性真菌感染的高危因素、臨床特點、治療和預後.方法 分析我科2002年3月至2010年7月行造血榦細胞移植術100例患者髮生侵襲性真菌感染26例患者的臨床資料.造血榦細胞移植前髮生肺部真菌感染7例;造血榦細胞移植後髮生肺部真菌感染14例,呼吸道真菌感染3例,腸道真菌感染2例.觀察侵襲性真菌感染患者的移植物抗宿主病的髮生、巨細胞病毒血癥髮生、淋巴細胞亞群檢測、閤併其他慢性基礎疾病情況.將侵襲性真菌感染患者分為2組,擬診經驗性治療組12例及臨床診斷搶先治療組14例.結果 26例侵襲性真菌感染的患者閤併移植物抗宿主病20例,閤併巨細胞病毒血癥6例,細胞免疫功能低下的19例.閤併糖尿病5例,肺結覈3例,支氣管擴張1例.經驗性治療組完全治愈8例(67%),疾病進展1例(8%).搶先治療組完全治愈3例(21%);疾病進展5例(36%),2組比較差異有統計學意義(χ2=5.418,P<0.05).結論 造血榦細胞移植存在侵襲性真菌感染高危因素的患者更應引起臨床醫師高度的重視.
목적 탐토이기인조혈간세포이식환자발생침습성진균감염적고위인소、림상특점、치료화예후.방법 분석아과2002년3월지2010년7월행조혈간세포이식술100례환자발생침습성진균감염26례환자적림상자료.조혈간세포이식전발생폐부진균감염7례;조혈간세포이식후발생폐부진균감염14례,호흡도진균감염3례,장도진균감염2례.관찰침습성진균감염환자적이식물항숙주병적발생、거세포병독혈증발생、림파세포아군검측、합병기타만성기출질병정황.장침습성진균감염환자분위2조,의진경험성치료조12례급림상진단창선치료조14례.결과 26례침습성진균감염적환자합병이식물항숙주병20례,합병거세포병독혈증6례,세포면역공능저하적19례.합병당뇨병5례,폐결핵3례,지기관확장1례.경험성치료조완전치유8례(67%),질병진전1례(8%).창선치료조완전치유3례(21%);질병진전5례(36%),2조비교차이유통계학의의(χ2=5.418,P<0.05).결론 조혈간세포이식존재침습성진균감염고위인소적환자경응인기림상의사고도적중시.
Objective To explore the high-risk factors,clinical characteristics,therapy and prognosis of invasive fungal infection (IFI)in patients underwent allogeneic haemopoietic stem cell transplantation (AlloHSCT). Methods One hundred patients underwent Allo-HSCT at our department from March 2002 to July 2010 were analyzed retrospectively,among whom 26 patients had invasive fungal infection(IFI). Seven patients had pulmonary IFI before allo-HSCT, 14 patients had pulmonary IFI after allo-HSCT,3 patients had respiratory tract system IFI, and 2 patients had intestinal IFI. We observed the occurrence of Graft-versus-host disease (GVHD) ,cytomegalovirus( CMV )infection, Lymphocyte subsets and chronic basic diseases in patients with IFI. The twenty six cases were divided into two groups: experience therapy group with 12 cases and preemption therapy group with 14 cases. Results Among 26 patients with IFI,20 cases suffered from GVHD,6 cases had CMV infection,19 cases had low cellular immune function simultaneously. 1 case had diabetes,3 patients had pulmonary tuberculosis and 1 case had bronchiectasis as complications. In experience therapy groupe: 8 cases (67%)recovered completely but 1 case(8% )suffered from progressive infection. In preemption therapy groupe:3 cases ( 21% ) recovered completely but 5 cases ( 36% ) suffered from progressive infection. Conclusion Clinician should pay close attention to the patients with high-risk factors of IFI after allo-HSCT.
